Wednesday, April 18, 2012

Panic Attacks (Panic Disorder)

You retire and suddenly
have all this free time with no commitments - but does that make you happy?
Unfortunately, many people, who joined the group, have to admit that instead of
the happiness and enjoyment, that should experience following this life
transition, they are hit with terrible negative emotions and thoughts. We
already reviewed depression
and anxiety
in our previous posts. Today, we will investigate panic attacks, condition,
commonly associated with anxiety.

What are panic attacks?

Panic attacks are
frightening but fortunately physically harmless episodes. They can occur at
random or after a person is exposed to various events that may "trigger"
a panic attack. They peak in intensity very rapidly and go away with or without
medical help.

Panic attacks or symptoms of panic disorder are characterized by unexpected and
repeated episodes of intense fear. While there are considered as physically
harmless, in many cases they are accompanied by real physical symptoms such as
chest pain, heart palpitations, shortness of breath, dizziness or abdominal
distress.

Who is likely to get panic attacks?

Scientists provide the statistical estimates that about 5% of the population are
experience panic attacks during their lifetimes. Furthermore, about 1.7% of the
adult U.S. population ages 18 to 54 - approximately 2.4 million people -
experience symptoms of panic disorder in any given year. Women are twice as
likely as men to develop panic disorder, and it typically first occurs in young
adulthood. Roughly half of all people who have panic disorder develop the
condition before age 25.

Until recently, it has
been a long-standing concept that older people do not suffer from the condition
known as panic disorder. Associate professor of psychiatry Dr. Javaid Sheikh claims
that this concept is incorrect. "Contrary to popular belief, panic attacks
do not disappear as people age," said Sheikh, founding director of
Stanford's geriatric psychiatry program and associate chief of staff for mental
health at the Menlo Park branch of the Veterans Affairs Palo Alto Health Care
System. Because of the "general bias that older patients do not have panic
attacks," researchers have largely neglected the problem as a topic of
study, he said.

What are the varieties?

Panic attacks can range from mild to severe, and can occur infrequently or on a
regular basis. It is not unusual for a person with panic disorder to develop
phobias about places or situations where panic attacks have occurred, such as
in supermarkets or while driving. If the frequency of panic attacks increases,
the person may begin to avoid those situations all together, fearing another
attack may occur and help would not be immediately available. This avoidance
may eventually develop into agoraphobia, an inability to go beyond known and
safe surroundings because of intense fear and anxiety.

What are the causes of panic attacks?

Although scientific research has been conducted on the condition for many
years, the exact cause or causes of panic disorder remain unknown. Certainly
there is evidence that the tendency to have panic attacks can sometimes be
inherited. However, there is also evidence that panic may be a learned response
and that the attacks can be initiated in otherwise healthy people simply given
the right set of circumstances. Research into the causes of panic attacks is
ongoing.

However, several factors
may play a role in the onset of panic disorder:

Heredity

A tendency toward exaggerated awareness of
normal bodily reactions

Stressful life events

Research is inconsistent
as to whether nutritional deficiencies (for example, zinc or magnesium
deficiency) may be risk factors for panic disorder. While food additives like
aspartame, alone or in combination with food dyes, are suspected to play a role
in the development of panic attacks in some people, more research is needed to
understand their role in this disorder.

What are the symptoms of panic attacks?

Clinical description of
the panic disorder refers to experiencing recurrent unexpected Panic Attacks and
at least one of the attacks has been followed by 1 month (or more) of one or
more of the following:

Persistent concern about having additional
attacks

Worry about the implications of the attack or
its consequences (e.g., losing control, having a heart attack, "going
crazy")

A significant change in behavior related to the
attacks

So, to make a formal
diagnosis of panic disorder, a person must experience either four panic attacks
within a four-week period, or one or more attacks followed by at least a month
of persistent fear of having another attack. During one of those attacks a
minimum of four of the above noted symptoms must reach a peak within 10
minutes.

General symptoms which
might be, or might not be present in any particular panic attach episode:

Palpations, pounding heart or accelerated heart
rate

Trembling or shaking

Sensations of shortness of breath or smothering

Feeling of choking

Chest pain or discomfort

Nausea or abdominal distress

Feeling dizzy, unsteady, lightheaded or faint

Feeling detached from oneself or feelings of
unreality

Fear of losing control or of going crazy

Fear of dying

Numbness or tingling sensation

Chills or hot flashes

The panic attacks can be
so disabling that the person is unable to express to others what is happening
to them. A doctor might also note various signs of panic: The person may appear
to be very afraid or shaky or be hyperventilating (deep, rapid breathing that
causes dizziness).

Anxiety attacks that take place while sleeping, also called nocturnal panic
attacks, occur less often than do panic attacks during the daytime, but affect
about 40%-70% of people who suffer from daytime panic attacks. Individuals with
nocturnal panic attacks tend to have more respiratory symptoms associated with
panic and have more symptoms of depression and of other psychiatric disorders
compared to people who do not have panic attacks at night. Nocturnal panic
attacks tend to result in sufferers waking suddenly from sleep in a state of
sudden fright or dread for no known reason. As opposed to people with sleep
apnea and other sleep disorders, sufferers of nocturnal panic can have all the
other symptoms of a panic attack. Although nocturnal panic attacks usually last
no more than 10 minutes, it can take much longer for the person to fully
recover from the episode.

Recent literature suggests
that men and women may experience different symptoms during an attack. Women
tend to experience a predominance of respiratory symptoms compared to men.

Treatment for Panic Attacks

Treatment emphasizing a
three-pronged approach is most effective in helping people overcome this
disorder: education, psychotherapy and medication.

Psychotherapy

Education is usually the
first factor in psychotherapy treatment of this disorder. The patient can be
instructed about the body's "fight-or-flight" response and the associated
physiological sensations. Learning to recognize and identify such sensations is
usually an important initial step toward treatment of panic disorder.
Individual psychotherapy is usually the preferred modality and its length is
generally short-term, under 12 sessions. An emphasis on education, support, and
the teaching of more effective coping strategies are usually the primary foci
of therapy. Family therapy is usually unnecessary and inappropriate.

Therapy can also teach
relaxation and imagery techniques. These can be used during a panic attack to
decrease immediate physiological distress and the accompanying emotional fears.
Discussion of the client's irrational fears (usually of dying, passing out,
becoming embarrassed) during an attack is appropriate and often beneficial in
the context of a supportive therapeutic relationship. A cognitive or
rational-emotive approach in this area is best. A behavioral approach
emphasizing graduated exposure to panic-inducing situations is most-often
associated with related anxiety disorders, such as agoraphobia or social
phobia. It may or may not be appropriate as a treatment approach, depending
upon the client's specific issues.

Group therapy can often be
used just as effectively to teach relaxation and related skills.
Psychoeducational groups in this area are often beneficial. Biofeedback, a
specific technique which allows the client to receive either audio or visual
feedback about their body's physiological responses while learning relaxation
skills, is also an appropriate psychotherapeutic intervention.

All relaxation skills and
assignments taught in therapy session must be reinforced by daily exercises on
the patient's part. This cannot be emphasized enough. If the client is
unable or unwilling to complete daily homework assignments in practicing
specific relaxation or imagery skills, then therapy emphasizing such skill sets
will likely be unsuccessful or less successful. This pro-active approach to
change (and the expectations of the therapist that the client will agree to
this approach) needs to be clearly explained at the onset of therapy.
Discussing these expectations clearly up-front makes the success of such
techniques much greater.

Medications

A lot of people who suffer
from panic disorder can successfully be treated without resorting to the use of
any medication. However, when medication is needed, the most
commonly-prescribed class of drugs for panic disorders are the benzodiazepines
(such as clonazepam and alprazolam) and the SSRI antidepressants. It is rarely
appropriate to provide medication treatment alone, without the use of
psychotherapy to help educate and change the patient's behaviors related to
their association of certain physiological sensations with fear.

Phillip W. Long, M.D.
notes that, "Clonazepam (Klonopin, Rivotril) and alprazolam (Xanax), are
the treatment of choice in the treatment of Panic Disorder. Clonazepam and
alprazolam are preferred to antidepressant drugs because of their less severe
side effects." He also states that it is preferred to try the anti-anxiety
agents before moving on to the antidepressants because of the increased
side-effect profiles. Xanax can be addicting for individuals and should be used
with care. Treatment with either clonazepam or alprazolam should be
discontinued by tapering it off slowly, because of the possibility of seizures
with abrupt discontinuation.

Self-Help

Self-help methods for the
treatment of this disorder are often overlooked by the medical profession
because very few professionals are involved in them. Many support groups exist
within communities throughout the world which are devoted to helping individuals
with this disorder share their commons experiences and feelings.

Patients can be encouraged
to try out new coping skills and relaxation skills with people they meet within
support groups. They can be an important part of expanding the individual's
skill set and develop new, healthier social relationships.

There are some commonly
recognized approaches to help reduce symptoms associated with panic attacks:

Natural stress relieving activities. Lowering stress levels
with activities such as regular exercise, massage or simply walking it out
can help to keep the symptoms under control because stress can trigger or
aggravate panic disorder. It can be easier to cope with stress on a daily
basis if you schedule in regular stress relieving sessions.

Breathing
exercises. One of
the best single anti-anxiety measures, controlling breathing and breath
work can offer an immediate lessening of symptoms. Most people are not really
conscious about the way they are breathing, but when people are anxious
they tend to take rapid, shallow breaths that come directly from the
chest. This type of breathing is called thoracic or chest breathing. Chest
breathing causes an upset in the oxygen and carbon dioxide levels in the
body, resulting in increased heart rate, dizziness, muscle tension and
other physical sensations.

Progressive Muscle Relaxation. Progressive muscle relaxation (PMR) is a stress
and anxiety management technique. If you have panic disorder, agoraphobia
or another type of anxiety disorder, you may experience frequent muscle
tension. In fact, chronic muscle tension may be so automatic that it seems
normal, and you may have forgotten what it feels like when your muscles
are completely relaxed. By employing the progressive muscle relaxation
technique, you will be able to quickly rediscover the distinctions between
relaxation and tension of various muscle groups.

Creative visualization. During a panic attack, lots of things can go through your mind. Some
people think about disaster, or even death. Instead of letting your
imagination focus on these negative thoughts, try to concentrate on
positive images.Think of a
place or a situation that makes you feel peaceful, relaxed or at ease.
Once you know have this image in your mind, try to focus your attention on
it. It should help to distract you from the situation, and it may also
help ease your symptoms.Thinking
positively can be challenging, particularly if you have got used to
thinking negatively over a long period of time. Creative visualization is
a technique that will need practice, but you may gradually notice positive
changes in the way that you think about yourself and others.

Self-Modification Program. Self-modification programs focus on helping people
manage unwanted or dysfunctional behavioral responses when dealing with
their problems. For example, if you have panic attacks as a result of
panic disorder, a common dysfunctional behavioral response is avoidance.
Unfortunately, avoiding fearful situations does nothing to help in your
recovery from PD.

Do not
fight an attack. Fighting a
panic attack can often make the experience worse. Trying to resist the
attack and finding that you are unable to can increase your sense of
anxiety and panic.Instead,
during a panic attack, reassure yourself by accepting that although it may
seem embarrassing, and your symptoms may be difficult to deal with, your
attack is not life-threatening. Focus on the fact that your attack will
have an end and try your best to let it pass.

Start a Panic Diary. If you have panic disorder or agoraphobia, a panic
diary may help you to identify your panic attack triggers and your
responses to anxiety-provoking situations. It is usually best to record in
your panic diary as you are experiencing (or shortly thereafter) anticipatory
anxiety or a panic attack.

Monitor your diet. Eating certain types of foods can help to calm you down naturally, so
make sure you're not eating 'trigger' foods that may upset your nervous
system balance. Meet with a nutritionist or dietician to create a healthy
eating plan that's centered on wholesome foods that won't cause excessive
anxiety.

Panic Attacks Prevention

Following the practices of a healthy lifestyle can help, including eating well
and getting regular exercise. Using mind-body approaches and relaxation
techniques to reduce stress and anxiety can also help keep you centered and
minimize the impact of panic attacks.